Efficacy and Safety of Induction Therapy With Calcineurin Inhibitors in Combination With Vedolizumab in Patients With Refractory Ulcerative Colitis

Pellet, Gauthier; Stefănescu, Carmen; Carbonnel, Franck; Peyrin–Biroulet, Laurent; Roblin, Xavier; Allimant, Christophe; Nachury, Maria; Nancey, Stéphane; Filippi, Jérôme; Altwegg, Romain; Brixi, Hédia; Fotsing, Ginette; Rosamel, Laure de; Shili, Sarah; Laharie, David

doi:10.1016/j.cgh.2018.08.081

Cited by 64 publications

(44 citation statements)

References 17 publications

(17 reference statements)

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“…Indeed, our study showed that in this very sick cohort of patients, a substantial proportion of patients were able to avoid colectomy in the short and long term by inducing patients with CNIs and transitioning to vedolizumab as maintenance therapy. Unlike the study by Pellet G et al in our patient cohort, there was no significant difference between patients who met Truelove and Witts criteria for ASUC and those that did not in regards to colectomy free survival ( P = 0.8). However, patients with ASUC did have numerically higher colectomy rates at 3 months and 1 year when compared to those without ASUC (9.5% and 37.1% vs 6.25% and 19.65% respectively).…”

Section: Discussioncontrasting

confidence: 99%

“…There have been two previous studies and a case series of two patients that demonstrated the feasibility of inducing remission with ciclosporin followed by maintenance of remission with vedolizumab. However, both studies had limitations, including small patient numbers and limited follow‐up time.…”

Section: Discussionmentioning

confidence: 99%

“…The second study by Pellet G et al was a multicentre retrospective study from France. In this study, information was collected on 39 patients with steroid‐refractory UC.…”

Section: Discussionmentioning

confidence: 99%

“…tolerated in our cohort, with relatively few adverse events.The strength of this study includes its large cohort of patients, larger than all previously reported studies combined, as well as the long median follow-up of over 2 years.There have been two previous studies11,12 and a case series of two patients 13 that demonstrated the feasibility of inducing remis-sion with ciclosporin followed by maintenance of remission with vedolizumab. However, both studies had limitations, including small patient numbers and limited follow-up time.…”

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confidence: 99%

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Efficacy and safety of induction therapy with calcineurin inhibitors followed by vedolizumab maintenance in 71 patients with severe steroid‐refractory ulcerative colitis

Ollech

Dwadasi

Rai

et al. 2019

Aliment Pharmacol Ther

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Summary Background Following induction therapy with a calcineurin inhibitor (CNI) in severe ulcerative colitis, transitioning to vedolizumab as maintenance therapy could be an option. Aim To report on the largest cohort of patients successfully induced with CNIs who were transitioned to vedolizumab maintenance therapy. Methods This is a retrospective observational study of adult patients with severe steroid‐refractory ulcerative colitis. Patients were included if they were induced with a CNI followed by maintenance therapy with vedolizumab between January 2014 and December 2018. The primary endpoint was colectomy‐free survival. Secondary endpoints included survival without vedolizumab discontinuation as well as clinical, steroid‐free and biochemical remission at week 14. Results A total of 71 patients (59% male) were treated with vedolizumab after induction therapy with CNIs for severe steroid‐refractory colitis. Patients were followed for a median time of 25 months (IQR 16‐36). Colectomy‐free survival rates from vedolizumab initiation were 93% at 3 months, 67% at 1 year and 55% at 2 years. At the end of induction with vedolizumab at week 14, 50% of patients were in clinical remission, and 62% of patients had a normal CRP. At 1 and 2 years following vedolizumab initiation, 43% and 28% of patients were still on vedolizumab respectively. Vedolizumab was dose escalated to infusions every 4 weeks in 44% of patients. The median time to dose escalation was 5.6 months (IQR 4.1‐8.2). No serious adverse events were recorded in our patient cohort. Conclusions Transitioning to vedolizumab following induction of remission with CNIs is effective and safe.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The second study by Pellet G et al was a multicentre retrospective study from France. In this study, information was collected on 39 patients with steroid‐refractory UC.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Efficacy and safety of induction therapy with calcineurin inhibitors followed by vedolizumab maintenance in 71 patients with severe steroid‐refractory ulcerative colitis

Ollech

Dwadasi

Rai

et al. 2019

Aliment Pharmacol Ther

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“…Cyclosporine, while itself not appropriate for maintenance therapy, is an effective bridge to an alternative medication that is approved for UC maintenance. For example, cyclosporine in the acute hospitalized setting as a bridge to vedolizumab in the outpatient setting is one therapeutic approach [54].…”

Section: Acute Severe Ulcerative Colitismentioning

confidence: 99%

Ulcerative Colitis: Current and Emerging Treatment Strategies

Kayal

Shah

2019

JCM

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Review article: Updated management of acute severe ulcerative colitis: From steroids to novel medical strategies

Calméjane

Laharie

Kirchgesner³

et al. 2023

UEG Journal

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Acute severe ulcerative colitis (ASUC) occurs in up to 25% of patients with ulcerative colitis (UC). Therapeutic approaches have evolved during the past years with the increasing bio exposure of admitted patients and the extension of the number of approved drugs for UC. In this review, we aimed to summarize the latest evidence in short‐term and long‐term medical strategies for ASUC. In addition to general principles such as venous thromboembolism prophylaxis, screening for triggering and worsening factors and close monitoring, first‐line therapy for ASUC remains intravenous corticosteroids. In naive patients, the optimum maintenance strategy for steroid‐responding patients does not necessarily include biologics. Second‐line therapy includes infliximab or calcineurin inhibitors (CNIs) with similar short‐ and long‐term colectomy rates. Despite its pathophysiological relevance, there is insufficient evidence to promote intensified induction with infliximab. Prior treatment exposure is a cornerstone for guiding therapeutic choice of short‐ and long‐term therapies in the context of ASUC: in anti‐TNF exposed patients, CNIs may be favored as a bridge therapy to vedolizumab or ustekinumab. Third‐line salvage therapy could be a therapeutic option in selected patients referred to expert centers. Additionally, evidence is accumulating regarding the use of tofacitinib in ASUC.

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Efficacy and Safety of Induction Therapy With Calcineurin Inhibitors in Combination With Vedolizumab in Patients With Refractory Ulcerative Colitis

Cited by 64 publications

References 17 publications

Efficacy and safety of induction therapy with calcineurin inhibitors followed by vedolizumab maintenance in 71 patients with severe steroid‐refractory ulcerative colitis

Efficacy and safety of induction therapy with calcineurin inhibitors followed by vedolizumab maintenance in 71 patients with severe steroid‐refractory ulcerative colitis

Ulcerative Colitis: Current and Emerging Treatment Strategies

Review article: Updated management of acute severe ulcerative colitis: From steroids to novel medical strategies

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